Prevalence, characteristics and clinical implications of regular atrial tachyarrhythmias in patients with atrial fibrillation: insights from a study using a new implantable device
Carsten W. Israel, MD*,
Joachim R. Ehrlich, MD*,
Gerian Grönefeld, MD*,
Armin Klesius, MD*,
Thomas Lawo, MDb,
Bernd Lemke, MDb and
Stefan H. Hohnloser, MD, FACC, FESC*
* Department of Medicine, Division of Cardiology, J. W. Goethe University, Frankfurt, Germany
b the Department of Medicine, Division of Cardiology, Ruhr-University Bochum, Bergmannsheil, Bochum, Germany
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Figure 1 Classification of atrial tachyarrhythmia (AT) on the basis of analysis of stored bipolar electrograms. a) Type I: highly organized AT with discrete deflections of constant morphology, an isoelectric line between signals and a minimal cycle length  200 ms. b) Type II: intermediate type of organization not meeting the definition of type I or type III. c) Type III: disorganized AT with polymorphic deflections, no isoelectric line between signals and a minimal cycle length <200 ms. AS = atrial sense; FD = fibrillation detection interval; FS = fibrillation sense; TF = tachycardia/fibrillation (overlap zone); TS = tachy sense.
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Figure 2 Episodes of atrial tachyarrhythmia (AT) (solid bar = type I; shaded bar = type II; open bar = type III) at onset and confirmation of AT persistence 1 min later on the atrial electrogram (AEGM).
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Figure 3 Number of type I (highly organized) or type II/III (less organized) atrial tachyarrhythmia (AT) episodes on the atrial electrogram at onset (left) and after 1 min of AT (right).
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Figure 4 Antitachycardia pacing success rates in types I, II and III of atrial tachyarrhythmia (AT) episodes.
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Figure 5 Examples of atrial antitachycardia (ATP). (A) Primary termination of regular atrial tachyarrhythmia (AT) (type I, cycle length 260 ms) by burst-plus pacing. (B) Primary termination of type I AT (cycle length 250 ms) by ramp pacing. (C) Secondary termination of type I AT (cycle length 250 ms). After the last paced beat, there are four AT cycles before the AT ceases. Details are from stored AT episodes immediately before first ATP (with AEG) and during last ATP (no AEG available) (paper speed 25 mm/s). AP = atrial pace; AS = atrial sense; FDI = fibrillation detection interval; FS = fibrillation sense; TF = tachycardia/fibrillation (overlap zone); VP = ventricular pace; VS = ventricular sense.
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Figure 6 Distribution of atrial tachyarrhythmia (AT) types (solid bar = type I; open bar = type II; shaded bar = type III) among individual patients. In patients 1 and 2, only atrial flutter was previously documented, whereas in patients 3 to 5, atrial fibrillation (AF) and atrial flutter were documented. The only previously documented AT in patients 6 to 19 was AF.
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